Quick answer. A perforated eardrum is a hole or tear in the eardrum, usually from infection, injury, loud noise or pressure changes, causing ear pain, hearing loss or discharge. Most heal on their own within weeks if kept dry, but some need surgery.
A perforated eardrum – a tear or hole in the thin membrane between your ear canal and middle ear – can happen after a bad ear infection, a poke from a cotton bud, a slap to the ear or a sudden pressure change while flying or diving. It often causes a brief sharp pain, some hearing loss and sometimes discharge from the ear.
The reassuring news is that most perforated eardrums heal by themselves within a few weeks, as long as the ear is kept dry and free of further infection. This guide explains the causes, the symptoms, how it is diagnosed and treated, and the warning signs that mean you should see an ENT specialist rather than wait.
At a glance
| Cause | How it happens | Usual outcome |
|---|---|---|
| Middle ear infection | Pus builds up and bursts the eardrum | Often heals as the infection settles |
| Cotton bud or object | Direct injury to the eardrum | Usually heals if kept dry |
| Loud noise or blast | Sound pressure tears the membrane | Often heals; hearing usually recovers |
| Pressure change (flying, diving) | Barotrauma stretches or tears the drum | Variable; may need review |
| Head or ear injury | Trauma to the skull or ear | Needs prompt medical assessment |
What is a perforated eardrum?
The eardrum (tympanic membrane) is a thin, taut layer of tissue that separates your ear canal from the middle ear. It vibrates in response to sound and helps protect the middle ear from water and germs. A perforated eardrum is a hole or tear in this membrane.
It is a common condition that can affect both children and adults, and is often linked to ear infections in children. Many perforations are small and heal on their own. While the hole is present, hearing may be reduced and the middle ear is more vulnerable to infection, particularly if water gets in.
Symptoms and signs
A perforation may cause noticeable symptoms, though sometimes it is only picked up on examination. Common signs include:
- A sudden sharp ear pain, which may then ease quickly
- Hearing loss or muffled hearing in the affected ear
- Discharge from the ear, which may be watery, bloody or contain pus
- Ringing in the ear (tinnitus)
- A sensation of fullness, or occasionally brief dizziness
If the perforation followed an infection, the pain may actually improve as the trapped pus drains out through the new opening.
Causes and risk factors
A perforated eardrum can result from several causes:
- Middle ear infections – the most common cause, especially in children, when pressure from pus bursts the eardrum
- Direct injury – poking the ear with a cotton bud or other object
- Loud noise or blast injury – an explosion or very loud sound
- Pressure changes (barotrauma) – during flying or scuba diving
- A head injury or a forceful slap over the ear
Avoiding cotton buds inside the ear canal and treating ear infections promptly are the best ways to reduce the risk.
How it is diagnosed
A doctor or ENT specialist can usually diagnose a perforated eardrum by looking into the ear. Assessment may include:
- Otoscopy – examining the eardrum with a lighted instrument to see the hole and any discharge
- A hearing test (audiometry) to measure how much hearing is affected
- Tympanometry, which checks how the eardrum responds to pressure
- A swab of any discharge if infection is suspected
These tests help confirm the size and location of the perforation and guide whether it is likely to heal on its own.
Treatment options
Most perforated eardrums heal naturally within a few weeks. Treatment focuses on protecting the ear and treating any infection:
- Keep the ear dry – avoid getting water in the ear when showering or swimming, as moisture can cause infection and delay healing
- Antibiotics – ear drops or tablets if there is an active infection
- Pain relief with simple painkillers
- Avoid putting anything into the ear, including cotton buds
- Surgery (myringoplasty or tympanoplasty) – to patch the eardrum if a perforation does not heal after a few months or keeps causing infections and hearing loss
Your ENT specialist will advise whether to wait for natural healing or to consider a repair procedure.
When to see a doctor and which specialist
See a doctor if you think you have a perforated eardrum, particularly if there is discharge with fever or severe pain, hearing loss that does not improve, or if the perforation happened after a head injury, as that needs prompt assessment. Repeated or persistent discharge should also be checked. Go to A&E and call 995 if a head injury is accompanied by drowsiness, confusion, repeated vomiting or fluid leaking from the ear after trauma.
An Ear, Nose & Throat (ENT) specialist can confirm the diagnosis, treat infection, test your hearing and advise on whether surgery is needed. You can find one through our directory of ENT specialists in Singapore.
Keeping the ear dry while it heals
The single most useful thing you can do for a healing perforation is to keep water out of the ear. When showering or washing your hair, place a piece of cotton wool smeared with a little petroleum jelly in the outer ear, and avoid letting the shower spray directly into the ear. It is best to avoid swimming and diving until your doctor confirms the eardrum has healed. Do not put cotton buds, ear drops bought without advice, or any object into the ear, as these can introduce infection or cause further damage.
What to expect at the appointment
The doctor will ask how the problem started, for example after an infection, a cotton bud or a flight, and whether there is any discharge or hearing change. They will examine the ear with a lighted instrument and may arrange a hearing test. Many small perforations are simply reviewed again after a few weeks to confirm healing. If a repair is later needed, your ENT specialist will explain the procedure and recovery. Where surgery is medically indicated, day-surgery and inpatient costs may be partly covered by MediSave and MediShield Life in Singapore; check eligibility with your hospital rather than relying on a quoted figure.
Common questions
Will my hearing return to normal?
For most small perforations, hearing recovers as the eardrum heals. Larger holes, or those linked to ongoing infection or damage to the middle ear bones, may leave some lasting hearing loss, which an ENT specialist can assess.
Is it safe to fly with a perforated eardrum?
A perforation does not usually cause the pressure problems some people fear with flying, but if you have active infection or discharge it is sensible to seek advice first.
Related guides
- Best ENT Clinics in Singapore — our editorial shortlist
- ENT clinics directory
- Chronic sinusitis
- Labyrinthitis
- Glue ear
- Vocal cord nodules
- Uterine prolapse
Sources
- NHS – Perforated eardrum
- HealthHub Singapore – Ear conditions
- Mayo Clinic – Ruptured eardrum
- SingHealth – Ear, Nose and Throat conditions
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